SW5130501_CURRENT PERMIT_20130507

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW���
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
YYYYM M DD

a
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Division of Water.Quality
Charles Wakild, P.E.
Director
May 4, 2013
Lyle Westbrook, Trustee
Siler City Congregation of Jehovah's Witnesses
2191 Staley -Snow Camp road
Siler City, North Carolina 27344
Subject: Stormwater Permit No. SW5130501
Jehovah's Witness Kingdom Hall
Dear Mr. Westbrook:
John E. Skvarla, III
Secretary
The Stormwater Permitting Unit received a complete Stormwater Management Permit Application for Jehovah's
Witness Kingdom Hall in Siler City on May 3, 2013. Staff review of the plans and specifications has determined that
the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 02H.1000. We
are forwarding Permit No. SW5130501, dated May 4, 2013, for the construction, operation and maintenance of the
subject project and the stormwater 13MPs.
This permit shall be effective from the date of issuance until May 3, 2021, and shall be subject to the conditions and
limitations as specified therein, and does not supersede any other agency permit that may be required. Please pay
special attention to the conditions listed in this permit regarding the Operation and Maintenance of the BMP(s),
recordation of deed restrictions, procedures for changes of ownership, transferring the permit, and renewing the
permit. Failure to establish an adequate system for operation and maintenance of the stormwater management system,
to record deed restrictions, to follow the procedures for transfer of the permit, or to renew the permit, will result in
future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request an
adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The,'written
petition must conform to Chapter 150B of the North Carolina General Statutes. Per NCGS 143-215(e) the petition
must be filed with the OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all
questions regarding the filing fee (if a filing fee is required) and/or the details of the Fling process at 6714 Mai I
Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.NCOAH.com, Unless such demands are made this permit shall be final and binding.
This project will be kept on file at the Raleigh Regional Office. If you have any questions, or need additional
information concerning this matter, please contact Mike Randall at [phone]; or [e-mail].
Sincerely,
for C arles Wakild, PE, Director
cc: SW5130501 File MAY - 7 2013
Danny Smith — Raleigh Regional Office
ec: Mark Wisniowski — Trustee
Adam Pike, Stewart Consulting Firm
Wetlands and Slormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCarohna
Location; 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone [phone] FAX [phone] ;Vaturallff
Inlernet www.ncwaterquality.org rJ
An Equal oppo7unily iMtrmaliveAclion Employer

®Aftte Stormwater Permit
rmit No. SW5130501.
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Siler City Congregation of Jehovah's Witnesses
Jehovah's Witness Kingdom Hall
200 Eden Hills Road, Siler City, North Carolina
Chatham County
FOR THE
construction, operation and maintenance of one Wet Detention Basin in compliance
with the provisions of Session Law 2006-246 and 15A NCAC 2H .1000 (hereafter
referred to as the "stormwater rules') and the approved stormwater management plans
and specifications and other supporting data as attached and on file with and approved
by the Division of Water -Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until May 3, 2021, and shall be
subject to the following specified conditions and limitations:
1. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. The Wet Detention Basin are approved for the management of stormwater runoff
as described in the application documents and as shown on the approved plans.
3. All stormwater collection and treatment systems must. be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
4. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
5. The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent surface waters.
Page 1 of 4

rliv
to Stormwater Permit
rmit No. SW5130501
II. SCHEDULE OF COMPLIANCE
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
2. The permittee shall at all time provide the operation and maintenance necessary
to assure the permitted Wet Detention Basin functions at optimum efficiency.
The approved Operation and Maintenance Plan must be followed in its entirety
and maintenance must occur at the scheduled intervals including, but not limited
to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans.
f. Debris removal and unclogging of all drainage structures, level spreader,
filter media, planting media, underdrains, catch basins and piping.
g. Access to the cell and outlet structure must be available at all times.
3. Records of maintenance activities must be kept for each permitted BMP. The
reports will indicate the date, activity, name of person performing the work and
what actions were taken.
4. The permittee shall submit to the Division of Water Quality an annual summary
report of the maintenance and inspection records for the Wet Detention Basin.
The report shall summarize the inspection dates, results of the inspections, and
the maintenance work performed at each inspection.
5. The Wet Detention Basin shall be constructed in accordance with the approved
plans and specifications, the conditions of this permit, and with other supporting
data.
6. Upon completion of construction, prior to. issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the Wet Detention Basin certifying that the
permitted facility has been installed in accordance with this permit, the approved
plans and specifications, and other supporting documentation. Any deviations
from the.approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion .Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
Page 2 of 4

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_to Stormwater Permit
rmit No. SW51305011
approved plan.
9. A copy of the approved plans and specifications shall be maintained on file by
the Permittee for a minimum of eight years from the date of the completion of
construction.
10. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form signed by both parties, to the
Division of Water Quality, accompanied by the supporting documentation. The
approval of this request will be considered on its merits and may or may not be
approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves a request to transfer the permit.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
Page 3 of 4

to Stormwater Permit
_r_mit No. SW5130501
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revolting and reissuing the permit, or terminating the permit,
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 4th day of May, 2013.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 4

ate Stormwater Permit
rmit No. SW5130501
Slier City Congregation of Jehovah's Witnesses
Jehovah's Witness Kingdom Hall
200 Eden Hills Road, Siler City, North Carolina
Chatham County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
Jehovah's Witness Kingdom Hall in Siler City, North Carolina
for Slier City Congregation of Jehovah's Witnesses hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
cc: NCDENR-DWQ Regional Office
Page 1 of 1

r-- w
DWQ USE ONLY
Date Received
Fee Paid
Permit Number
.0
-3OSo
Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW -
2008 ❑ Ph II - Post Construction
fselect all that apply) ❑ Non -Coastal SW- HQW/ORW Waters
❑ Universal Stormwater Management Plan
❑ Other WQ M =mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality MAY - 7 2013
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may he photocopied for use as an original
1. GENERAL INFORMA'ION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Jehovah's Witness Kingdom Hall - Siler City
2. Location of Project (street address):
200 Eden Hills Road
City:Siler Ci County:ChathanrLip:27344
3. Directions to project (from nearest major intersection):
Mahe aright off of 64 west onto Greensboro Ave. This becomes Old U.S. Hwy 421 North. Head north for 3
until you reach the intersection of Lden Hills Road and Old U.S. Hwv 421.
4. Latitude350 45' 31" N J" Longitude:-79029' 56" W ' of the main entrance to the project.
II. PERMIT INFORMATION:
I. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tReneraals zoith modifications also requires SWU-102 - Rent7val Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* "provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, and the previous name of the project, if different than currently
proposed,
4. a, Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major ®Sedimentation/Erosion Control: 1.9 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit. Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VP http://portal.ncdenr.org/web/wglwslsu/statesw/miles laws
Fonn SWU-101 Version 06Aug2012 Page I of

10
III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc, who owns the ro'ect):
Applicant/Organization:Siler City Congregation of lehovah's Witnesses
Signing Official & Title:Lyle lVestbrook - Trustee
b.Contact information for person listed in item la above:
Street Address:2191 StaleY - Snow Camp Rd.
City:Siler City State:NC Zip:27344
Mailing Address (if applicahle)2191 Staley = Sno%y Camp Rd.
City:Siler CityState:NC Zip:27344
Phone: {336 ) 622-3669 Fax: (336 ) 622-7111
1:mail:1.AWestbrookl @hottoail.com
Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b,Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (tf applicable):
City:
Phone:
Email:
State:
Fax:.( )
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: Mark Wisniowski - Project Coordinator _ T`
Signing Official & Title:Don Davidson - Trustee
b.Contact information for person listed in item 3a above:
Mailing Address:3030 Heritage Lane _
City:Burlington
Phone: [phone]
Email: [e-mail]
4. Local jurisdiction for building permits:
Point of Contact:
State:NC
Fax:
Phone #:
Zip:27215
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff from all ney" iniprevious area is to head south and be captured by two area drains. Runoff is then
piped to wet pond BMP. Portion of the site (previous area) will also sheet flow to swales on the east and %rest
erimeter of the site. Swales will discharge south of.the BMP.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the Cape Fear River basin.
4. Total Property Area: 1.81 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area': 1.81 acres
' Total project area spatl he ealculated to exe:lude the following the marinal pool of impounded structures, the area
between the banks of stremns and rill!°rs, the area below file Normal. High Water (NHIIV) line or Mean 'Hig1r Water
(MHW) lime, and coastal zoetlatrds landzoard fi•onr the NHW (or MHI�') line. The resultant )project area is used to
calculate overall percent brtill upon area (BUA). Nort-consfal.zoetlands laudruard of the NHW (c)r MHI,V) line trtay
he included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 76.90
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
storniwater BMP. For low density and other projects, use I for the whole properff area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Draina e Area
Drainage Area _
Receiving Stream Name
Blood Run Creek
Stream Class
C
Stream Index Number *
17-23-1.
Total Drainage Area (sf)
43754
On -site Drainage Area (so
43754
Off -site Drainage Area (so
0
Proposed Impervious Area'(so
33647
% Impervious Area** total
76.90
Impervious- Surface Area
Drainage Area 1
Drainage Area _
Drainage Area
Drainage Area _
On -site Buildings/Lots (sf)
5074
On -site Streets (so
0
On -site Parking (so
28573
On -site Sidewalks (so
0
Other on -site (so
0
Future (so
0
Off -site (sf)
0
Existing BUA*** (so
0
Total (so:
33647
* Stream Class and Index Nzcrnber can be determined at: htip://portal.rrcdetrr.or /zcg ei)At)fl/frs/csu/classifications
Form SWU-101 Version 06Aug2012 Page 3 of 6

l * lruppervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that anrount of existing B UA that will remain after deueloptnent. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
"11. How was the off -site impervious area listed above determined? Provide documentation., N/A
Pro'ects in Union County. Contact Dbf1Q Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per 15A NCAC 0 B , 0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from litt )ortai:ricdeiir.or ►vtb ,wq ws su bhi manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr:org web/ wq/wslsu/stateswlforms _docs. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office: may be
found by locating project on the interactive online map at http:/1po_rtal.ncdenr;or�;LKeblwcj/tiYs'Lsu[.mi� .)
Please, indicate that the following required information have'been pinvided'by:.initiaiink in the space provided
for each item. All original documents MUST be signed and inifialed in blue ink. Download the latest versions
for each submitted application package from http1,/portal.hcdenr.6r_g web/wglq vs/su/stat6w/fofriis- docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. W
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants NIA -
Form, (if required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENIZ. (For an Express review, refer to
htt)://www.envhelp.org/pages/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1h mile of the site boundary, include the
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
eaters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
Np
. Nr
A(P
Nr
/MCP
NP
Form SWU-101 Version 06Aug2012 Page 4 of 6

t m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations,
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy.of,any applicable soils report with, the.associated SHWT elevations (Please identify A(P
elevations in addition to depths) as %yell asavniap of tlie.boring locations%-Ath the existing
elevations and boring.logs. Include an 8.5"x1l" copy of the NRCS Count), Soils map. with the
project aria clea�ly'delineated. F= r projects With infiltration-BMPs; the'reportshould also
include th&soil type, expected infiltrhtion rate; and the.method of determining the infiltration rate.
(Infiltratiori,Devices`submitted to WiRO: Si:Iohdc: a'site visit fnr DWQ to ver•rfit:the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: I 2-Li? Page No:
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC 1V/A _
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 21-1.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http: / /.►%,ww:secretaU..state.nc_.us/Corporations/CSeareh,aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
lift brtal.iudei�r.or well �r �s sii statesw foriils does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
Vill. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Adam I'ike
Consulting Firm: Stewart
Mailing Address:421 Fayetteville St. Suite 400
City:Raleigh State:NC Zip:27601
Phone: (919 .. } 866-4805 Fax: (91.9 } 380.8752
Irmail:�pikeCQstewartinc:coir►�
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, iten► 2 has beer filled out, complete this
section)
1, (print or type name of person listed in Contact Mforrrtatioti, itern 2a) /- f L fF /3 JZoo/C Certify that 1
own the property identified in this permit application, and thus give permission to (print or type ►iante of person
listed in Contact Information, item ]a) with (print or type name of organization listed in
Contact Information, item 1a) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
rorm SWU-101 Version 06Aug2012 Page 5 of

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Norm within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit, 1 understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signatu
Date:
-1 LCyiL os� 4 n , a Notary Public for the State of N Y lD1 i rY , County of
0-)Q,A-y'0 -r, , do hereby certify that L- N personally appeared
before me this ? 4day of r ti (k'1
knowledge the due execution of the application for
a stormwater permit. Witness my hand and official
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires L_J�
1; (print or type naine of person lister! in Contact Information, item 1a) L-' Lf' W E�S 7,6 2 U D )<
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Si
Date:
C(J Mioc— —County of
na do hereby certify that L � [y '' personally appeared
before me this day of �— ._ an�c y� nowledge the due ex el1tion of the application for
� r
a stormwater permit. Witness my hand and official�al, }C —�
SEAL
My commission expires 00 a. , Q(-)I '-i-
Form S W U-10 l V ersion 06A ug2012 Page 6 of 6

'SILER CITY.CONG OF JEHOVAHS WITNESSES
;.
" 77k
BUILDINGGFLfND" . s 524
'.3670,ALSTQWB.RIDGE RD r
'SILER
CITY' NC 27344-9318
Date _1tiJ�sf4f�
�
'
A Y�o the
V Law
/ -
-Dollars 8 ",
8
WO U EREQUIRED •. -
}t rR'a�T3
a
j7.—
BRANCH BANKING AND TRUST COMPANY r
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. ':
SILE1
R CITY, NORTH.CAROL•INAFor
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+: 0 S, I C) , 2 11: 5 2 9 0 8 4 7 2' 3 2'0 d.0 S 2 E,

Permit Number:
(!o be provided by DU'Q)
Drainage Area Number:
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ® does not incorporate a vegetated filter at the outlet. MAY - 7 2013
This system (check one):
❑ does ® does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
- Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
- No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
- Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
- Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and
within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a
Coastal County). Records of operation and maintenance should be kept in a known set
location and must be available upon request.
hnspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of
long.
approximately six inches.
Form SW40I-Wet Detention Basin O&M-Rev.4 Page ] of 4

Permit Number:
(to he provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate the problem -
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
swale,
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than s ra yin .
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-itev.4 Page 2 of.

Permit Number:
(to he provided by DWQ)
Drainage Area Number:
BMP element:
Potential roblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads 5 feet in the main pond, the sediment
shall be removed.
When the permanent pool depth reads 3 feet in the forebay, the sediment shall
be removed.
Sediment Removal
Bottom Elevat
BASIN DIAGRAM
(fill ira the hlunkv)
64 Pe manen`t,
------------------ Volume
64� I]-,
tt Min.
ediment
Storage
Pool
Permanent Pool Elevation 646
Sediment Removal Elevation 641 Volume
Bottom Elevation 640 j 1-ft
Storage
FOREBAY
MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page ') of 4

Permit Number:
(to he provided by UYVQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Jehovah's Witness Kingdom Hall - Siler Cites
BA4P drainage area number: I
Print name:
Title:
Address -.—
Phone:
Signature:
Date:
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
I, , a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this
day of and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
SEAL
My commission expires
Form SW401-Wet Detention Basin O&M-Rev.4 Page 4 of 4